Full-Endoscopic Posterior Cervical Decompression Versus Anterior Cervical Discectomy and Fusion: A Systematic Review and Meta-Analysis

Study designSystematic review and meta-analysis of randomized controlled trials and cohort studies directly comparing full-endoscopic posterior cervical decompression (PECD) with anterior cervical discectomy and fusion (ACDF) in adults with degenerative cervical disease.ObjectiveTo compare full-endoscopic posterior cervical decompression with anterior cervical discectomy and fusion for degenerative cervical disease.MethodsPubMed, Embase, and CENTRAL were searched through September 2025 for randomized and cohort studies in adults with ≥ 6 months' follow-up directly comparing PECD and ACDF. NDI, VAS neck/arm pain in short-term and long-term follow up, C2-C7 Cobb angle, peri-operative metrics, and adverse events were pooled using random-effects models with 95% confidence intervals.ResultsTen studies (2 RCTs, 8 cohorts) comprising 862 patients (PECD 433; ACDF 429) with 6 months to 2.5 years of follow-up were included. NDI and VAS arm pain scores did not differ significantly at final follow-up. PECD showed greater short-term functional improvement (NDI MD 2.46, 95% CI 1.55-3.36), whereas ACDF achieved slightly greater long-term neck pain improvement (VAS neck MD -0.24, 95% CI -0.43 to -0.04). C2-C7 Cobb angle and operative time did not differ. PECD was associated with a shorter hospital stay (MD -1.64 days, 95% CI -2.31 to -0.97) and lower blood loss (MD -44.85 mL, 95% CI -79.8 to -9.89), though these perioperative outcomes demonstrated substantial heterogeneity. Additionally, PECD was associated with a significantly lower risk of postoperative complications (RR 0.53, 95% CI 0.34-0.81); whereas ASD and index-level re-operation rate did not differ.ConclusionsPECD provides comparable mid-term disability and arm pain relief to ACDF with faster early recovery and lower perioperative morbidity, while ACDF offers marginally better long-term axial neck pain improvement.